The impact of endovascular aneurysm repair for ruptured abdominal aortic aneurysms: a single center experience

Abstract

Abstract Background Treatment of ruptured abdominal aortic aneurysms (rAAAs) is still burdened by high morbidity and mortality, despite improvements in 30-day mortality, recently reported at around 30-35%. Although endovascular aortic repair (EVAR) offers encouraging results in elective setting, the evidence supporting its use as the primary treatment for patients with rAAAs remains controversial. Endovascular approach for rAAA has been increasing worldwide. According to some recent studies, rEVAR is associated with diminished 30-day mortality, but its superiority in long-term results in terms of mortality and morbidity is still to be defined. Purpose We review our single center experience of EVAR for all patients who had rAAA over 8 years. Methods A retrospective review of data extracted from medical records identified 82 consecutive patients with rAAA who were underwent endovascular repairs from January 2014 to December 2021. We used EVAR first protocol for all patients. Under local anesthesia, percutaneous puncture of both common femoral arteries and left brachial artery is performed. Endovascular balloon control (EBC) is placed at T12 or L1 through the left brachial artery. Induction of general anesthesia can then be obtained. Then it can be done EVAR in the usual fashion. The primary end point was to assess the rAAA-related mortality in the immediate postoperative period, within 1, 3 and 5 years after EVAR; secondary endpoints included the following: length of stay, rAAA-related postoperative complications such as acute limb ischemia, myocardial infarction, renal and respiratory failure, abdominal compartment syndrome and rAAA-related re-interventions. Results EVAR was performed in all patients. There were no patients who converted to open surgical repair. The average age of the patients was 77 years, and 76% were male. 64% were sent from other hospitals, and 60% presented with severe hypotension. Anatomically, 52 cases, or 63%, were considered ineligible for EVAR. EBC were used in 72%. In early results, 12% of patients required dialysis due to acute kidney injury, and 9% required prolonged intubation with tracheotomy. Abdominal compartment syndrome occurred in 8%. Perioperative deaths occurred in 10 patients (12.1%), all within 48 hours after surgery. In late outcomes, mean follow-up was 1100. No new complications were seen after the 30-day period. Endovascular reinterventions took place in 11%. The average time to re-intervention was 372 days, with the majority of cases taking less than a year. The overall survival rates at 1, 3, and 5 years were 71.9%, 66.3%, and 66.3%, respectively. Conclusions EVAR for rAAA is associated with lower perioperative and long-term mortality with our protocol. This single-center experience suggests genuine concerns and impediments to the adoption of an ‘‘EVAR-first’’ policy for all rAAAs.